#1
What does CMS stand for in the context of medical billing?
Centers for Medicare & Medicaid Services
ExplanationGovernment agency overseeing Medicare and Medicaid programs.
#2
Which of the following is NOT a commonly used medical code set for billing and claim completion?
HIPAA
ExplanationHIPAA is a privacy regulation, not a medical code set.
#3
Which entity is responsible for assigning CPT codes?
The American Medical Association (AMA)
ExplanationProfessional organization responsible for medical code sets.
#4
Which of the following is NOT typically included in a patient's demographic information for billing purposes?
Marital Status
ExplanationMarital status usually isn't relevant for billing.
#5
What does the term 'payer' refer to in the context of medical billing?
The insurance company or entity responsible for payment
ExplanationEntity responsible for reimbursing healthcare services.
#6
In medical billing, what does the term 'EOB' typically refer to?
Explanation of Benefits
ExplanationStatement summarizing services billed, payments, and charges.
#7
Which of the following is a potential reason for a claim denial in medical billing?
Upcoding
ExplanationIncorrectly assigning a higher-level code than warranted.
#8
What is the primary purpose of a UB-04 form in medical billing?
To bill inpatient services
ExplanationStandard form for institutional claims.
#9
What does the term 'clean claim' refer to in medical billing?
A claim with complete and accurate information
ExplanationA claim that requires no additional information or documentation.
#10
What is the purpose of the National Provider Identifier (NPI) in medical billing?
To identify healthcare providers
ExplanationUnique identifier for healthcare providers.
#11
What is the purpose of using modifiers in medical billing codes?
To add additional information to the procedure code
ExplanationModifiers clarify circumstances for procedures.
#12
What is the purpose of the Clearinghouse in medical billing?
To submit claims to insurance companies electronically
ExplanationMiddleware between healthcare providers and insurers.